Respiratory syncytial virus vaccination: likely and less likely outcomes

Purpose of review: Respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract infections in infants, older adults, and high-risk populations. The recent approval of new RSV vaccines and monoclonal antibodies marks a turning point in RSV prevention. This review explores these advancements, their immediate and potential long-term effects, and the remaining challenges. Recent findings: Several novel RSV prevention strategies have been approved, including maternal RSVPreF vaccines, infant-targeted monoclonal antibodies like Nirsevimab, and vaccines for older adults. These interventions significantly reduce RSV-related hospitalizations, ICU admissions, and mortality, particularly in high-risk groups. Early evidence also suggests benefits in reducing wheezing during infancy; however, long-term impacts on asthma development remain uncertain. Challenges such as vaccine hesitancy and limited access in low-resource settings remain pressing issues that require sustained focus. Summary: RSV vaccines and monoclonal antibodies are expected to alter clinical management and public health by reducing severe disease burden and RSV transmission. Further research is needed to evaluate their long-term effects, including implications for asthma prevention and pediatric obstructive sleep apnea. Addressing access disparities and public acceptance will be critical for maximizing their global impact.